Of his unpopular move to the Western Cape, Househam recalls doctors gathered in protest in Groote Schuur Hospital's Palm Court after his cutting of beds there, and at Tygerberg Hospital, repeated accusations of 'putting cash before care' and of 'destroying a national asset'. He openly admits that he owes his initial public service career to the ANC, but stresses that once he became a public servant he deliberately avoided membership of any political party. When he retired from active public service last month, Househam was the longest-serving head of health in the country, the last remaining incumbent from 1995.
An analysis of why Free State delivery/management has failed so dramatically and what could have prevented similar situations elsewhere was essential 'for an effective government in SA, but also for the very future of democracy', he warned. Househam described healthcare complexities as potentially paralysing, particularly for inexperienced managers, and advised: 'Look for the simple in the complex, because it is there if you look for it and once you have identified the key issues, deal with them.' Bemoaning the ongoing and now-accelerating healthcare delivery implosion in the Free State, he said that within 3 years of his leaving there in February 2001, everything he'd achieved had been dismantled (his provincial health department had consistently remained within budget and had built up a 'competent management team'). Recalling his early days managing and transforming the Free State health department, Househam said workdays were often 20 hours long and 'weekends became workdays' - but he quickly learnt the 'trick of reducing seemingly complex healthcare issues to simplicity by getting the basics right'.
Househam was subsequently appointed chief specialist/head of the Free State University's Department of Paediatrics and Child Health (late 1988 to early 1995), where he had been lecturing for several years. Once South Africa (SA)'s first democratic elections were over, the party wasted no time in seconding the Princeton, New Jersey-born and University of Cape Town (UCT)-trained paediatrician to co-ordinate the Free State's strategic health and welfare management team - and to help advise on the same issues at national level. Househam joined the ANC in the early 1990s after cutting his medicopolitical teeth in bringing together the skills, academic knowledge and resources of the University of the Free State to better serve Bloemfontein's majority black population (via a community project in Mangaung still significantly funded by the Kellogg Foundation). It was here that he stiffened regulation of the Remuneration for Work Outside the Public Service (RWOPS) and cut commuted overtime, earning the epithet of 'the butcher' as he grasped the nettle of limited resource allocation to deliver more care to more people, often at the expense and outrage of high-end specialists. Househam, 65, earned his 'hard-core' reputation while serving as the first health chief of the Free State immediately after the country's first democratic elections, appointing and mentoring a raw but first-ever representative management team and integrating the former homelands of QwaQwa and Bophuthatswana. He willingly braved collegial umbrage when he believed a greater public good was at stake, and craftily confronted his political masters by deliberately provoking a near-uprising of doctors that made Pretoria so uncomfortable that seemingly threatened specialised Western Cape services were eventually retained. Craig Househam, who retired as Western Cape health chief in March, was above all a strategist. He may be remembered as 'the axe man' for his radical fiscal discipline, which included cutting beds in top tertiary hospitals, regulating private work and slashing commuted overtime, but Prof. The 'axe man' departs, offering hard-won lessons